tbuckley/cabot-search huggingface dataset:
Frailty and pre-frailty associated with physical functional performance and quality of life in breast cancer and bone marrow transplant survivors.
Authors: Shuo Wang, Hok Sreng Te, Qing Cao, Matthew J. Yousefzadeh, Char Napurski, Mukta Arora, Helene Barcelo, Laura Niedernhofer, Bharat Thyagarajan, Anna Prizment, Najla H. El Jurdi, Anne Hudson Blaes
Journal: Journal of Clinical Oncology (2023)

12064 Background: Frailty in cancer survivors poses a great challenge to health care providers. Frailty is associated with premature mortality, functional decline, and poor quality of life (QOL). We aimed to examine the associations of frailty and pre-frailty with physical functional performance and QOL in breast cancer survivors and bone marrow transplant (BMT) survivors. Methods: 43 breast cancer survivors and 55 BMT survivors who had received chemotherapy and did not have active cancer were recruited to the study. Based on Fried frailty phenotype, survivors were classified as frail if 3 or more criteria were present: unintentional weight loss, exhaustion, slow walking speed, low physical activity, and weakness. Pre-frail was classified if 1 or 2 criteria were present. Physical functional performance was assessed by Karnofsky performance scale (KPS) and continuous summary performance score (CSPS, comprises walking speed, standing balance, and repeated chair stands tests). p16 INK4a , a marker for cellular senescence, was measured from survivors’ blood samples. QOL was measured using the 36-Item Short Form Survey. Groups were compared using chi-square test for categorical variables and rank-sum test for continuous variables. Results: Median age of survivors was 59 yrs (39% male). 13% of survivors (N = 13) were frail and 26% (N = 25) were pre-frail. Frail/pre-frail survivors tended to be older, male, and BMT survivors and had worse results for KPS, walking speed, repeated chair stands, and CSPS (p-values&lt;0.03). Frail/pre-frail versus non-frail survivors had a higher p16 INK4a expression (p-value&lt;0.01). For QOL, frail/pre-frail survivors had lower median scores of physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, social functioning, bodily pain, and general health (p-values&lt;0.04), but the median scores of emotional well-being for frail/pre-frail and non-frail survivors were similar (p-value=0.06). Conclusions: Frailty and pre-frailty in a study of breast cancer and BMT survivors were associated with worse physical functional performance, higher p16 INK4a expression, and lower quality of life. [Table: see text]
Effect of immunotherapy cessation without disease progression on outcomes in patients with metastatic non-small cell lung cancer.
Authors: Blake McKinley, Shenduo Li, Nathaniel Wiest, Emily Butts, Tanmayi Pai, Jing Wang, Osama M Mosalem, Guilherme Sacchi de Camargo Correia, Jaydeepbhai Patel, Hiren Koshiya, Jyothik Varun Inampudi, Yujie Zhao, Rami Manochakian, Yanyan Lou
Journal: Journal of Clinical Oncology (2023)

e21156 Background: Immunotherapy (IO) is one of the major treatments for patients with metastatic non-small cell lung cancer (mNSCLC). IO may be discontinued in patients for many reasons, the most common being progression of disease (POD). For those patients who discontinued IO for reasons other than POD, such as immune-related adverse event (irAE), there is limited data that compare progression-free survival (PFS) and overall survival (OS) when IO is continued vs. stopped. Methods: We conducted a retrospective study of all patients with mNSCLC (stage IV) treated with IO at our institution from 2011 to 2022. Patients who discontinued IO due to POD were excluded from the analysis. The clinical outcomes, including PFS, OS, and irAE were investigated among patients with no POD who stopped IO prior to 6 or 12 months (m) vs. those that continued IO &gt; 6 or 12m. Results: The analysis at the 6m timepoint included 92 patients, 82.6% were white, 50% were male, 67.4% had adenocarcinoma, and 82.6% used tobacco. The most common site of metastasis was bone (28.3%), followed by CNS (20.7%). 51.2% of patients had received IO as the first line systemic therapy and 32.6% received it as their second. Pembrolizumab was the most used IO (84.78%). Among these patients, 25 discontinued IO before 6m, and 67 patients continued IO beyond 6m. irAE, of any grade, occurred in 44.0% vs 37.3% when comparing IO discontinued with IO continued group at 6m. Patients who continued treatment beyond 6m had a longer duration of PFS (22.8m vs 11.8m, p = 1.14E-04) with a significant increase in OS (34.5m vs 14.0m, p = 1.34E-07). The analysis at the 12m timepoint included 71 patients, 87.3% were white, 46.5% were male, 78.9% had adenocarcinoma, and 80.3% used tobacco. The most common site of metastasis was bone (29.9%), followed by CNS (22.5%). 62.0% of patients had received IO as the first line systemic therapy and 28.7% received it as their second. Pembrolizumab was the most used IO (87.3%). Among these patients, 30 discontinued IO before 12m, and 41 patients continued IO beyond 12m. irAE, of any grade, occurred in 36.7% vs 41.5% when comparing IO discontinued with IO continued group at 12m. Similarly, patients who continued treatment beyond 12m had a longer duration of PFS (28.4m vs 14.2m, p = 1.91E-06) with a significant increase in OS (39.9m vs 17.6m, p = 3.45E-09). Conclusions: We observed that patients with mNSCLC and no POD, who continued IO beyond 6m and 12m, experienced a significant increase in PFS and OS than those who discontinued IO, with more significant increases in those who continued IO past 12m. These findings need to be verified in a larger cohort.
Feasibility of CAR-T in very old patients with relapsed/refractory diffuse large B-cell lymphoma.
Authors: Alon Rozental, Julio C. Chavez, Marina Sehovic, Frederick L. Locke, Aleksandr Lazaryan, Taiga Nishihori, Farhad Khimani, Michael D. Jain, Bijal D. Shah, Martine Extermann
Journal: Journal of Clinical Oncology (2023)

e19521 Background: Chimeric antigen receptor T-cell therapy (CAR-T) has shown great efficacy in older relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) patients (pts). Pivotal trials have shown similar progression free survival (PFS) and overall survival (OS) between older and younger pts, and no difference in the incidence of cytokine release syndrome (CRS), immune effector cell associated neurotoxicity syndrome (ICANS), or grade 3-4 hematologic and non-hematologic toxicities. Nevertheless, there are limited reports in the literature concerning very old pts (≥75 years) receiving CAR-T for R/R DLBCL, and especially real world data in correlation with co-morbidities. Methods: We conducted a retrospective, single center analysis, including R/R DLBCL pts who underwent apheresis for CAR-T at 75 and older. We assessed co-morbidities by Cumulative Illness Rating Scale (CIRS-G) tool which set a score of 0-4 on all organ systems according to severity, and polypharmacy at time of apheresis, defined as ≥5 medications per day. We analyzed baseline characteristics, response rates, toxicity, and survival outcomes (PFS and OS). Results: A total of 47 pts were referred for CAR-T treatment. Median age at apheresis was 76.6 (75-86) years. Most of these pts received first-line treatment with full or attenuated dose R-CHOP (89%). However, 20 pts (42.5%) had refractory disease, and those achieving PR/CR had a median time to relapse of 13 months. Thirty-two pts (68%) were referred for CAR-T with refractory disease. Six pts died before receiving the CAR-T infusion due to PD. Characteristics of 41 pts receiving CAR-T infusion divided into subgroups of pts with CIRS-G categories 3-4 and pts with polypharmacy are shown in the table. Conclusions: CAR-T in very old (≥ 75 years) R/R DLBCL is feasible with no increased toxicity. While efficacy is important, the preliminary survival analysis seems suboptimal. At 1-year follow-up only a third of pts are alive. Severe co-morbidities or polypharmacy did not impact response or survival. Most deaths were due to disease progression, these outcomes might be attributed to the high rate of refractory disease. [Table: see text]
Accelerated brain age and associated neurocognitive impairments in adult survivors of childhood cancer.
Authors: Nicholas Steve Phillips, Jessica L Baedke, AnnaLynn Williams, Qing Ji, Silu Zhang, Matthew Scoggins, Noah Sabin, Thomas E. Merchant, Amar J. Gajjar, Kirsten K. Ness, Melissa M. Hudson, Yutaka Yasui, Kevin R. Krull
Journal: Journal of Clinical Oncology (2023)

10028 Background: Structural brain aging assessed from routine clinical MRI exams is associated with neurologic and neurocognitive impairments in older non-cancer populations yet is unexplored in childhood cancer survivors. Methods: Neurocognitive assessments and clinical 3-D T1 MRI whole brain images were obtained on 253 childhood cancer survivors (acute lymphoblastic leukemia = 118; brain tumor = 49; Hodgkin lymphoma = 86) and 43 community controls. Brain age was estimated using open-source Gaussian process regression software (BrainAgeR) on visually inspected, segmented, and normalized MRI scans. Benjamin-Hochberg adjusted T-tests were used to compare age-adjusted neurocognitive z-scores between controls and survivors. Linear regression tested associations between brain age acceleration (brain age-chronological age) and treatment (multivariable), and neurocognitive outcomes (univariable). Results: Survivors (mean(SD) age 31.2[8.9]) had poorer executive function (Trails B survivors -0.72 vs controls 0.32, p &lt; 0.0001), processing speed (Grooved Peg Board -0.77 vs 0.05, p &lt; 0.0001), memory (visual selection -0.73 vs -0.10, p = 0.0010; digit backward span -0.45 vs 0.08, p = 0.0304), vocabulary (WASI vocabulary -0.43 vs 0.14, p = 0.0007), and reading (WJ letter word -0.43 vs -0.05, p = 0.0006) compared to controls. In survivors, mean[95%CI] brain age was 7.5[6.4 to 8.6] years older than chronologic age; 0.65[-1.0 to 2.3] years for controls. Compared to males without cranial radiation, for females age≥10 years at cancer diagnosis treated with ≥40Gy cranial radiation, brain age acceleration was 13.35 years (p &lt; 0.001), which worsened by an additional 9.81 years (p = 0.017) for those diagnosed &lt; 10 years. Greater brain age acceleration was associated with a worse performance in executive function (β = -1.73, p &lt; 0.001), processing speed (β = -2.18, p &lt; 0.001), memory (β = -2.07, p &lt; 0.001; β = -1.78, p &lt; 0.029), vocabulary (β = -2.04, p &lt; 0.001), and reading (β = -3.77,p &lt; 0.001). Conclusions: Survivors of childhood cancer experience significant brain age acceleration that is associated with impairments in neurocognitive function. In non-cancer populations, accelerated brain age has been shown to predict late morbidities and mortalities. BrainAge is a promising surrogate biomarker that could predict cognitive decline and improve early detection of dementia risk. Finally, it highlights the risk of cranial radiation in &lt; 10-year-old female cancer survivors.
Multicenter real-world study of newly diagnosed advanced-stage extranodal natural killer/T-cell lymphoma (ENKTL): Proposal for intensive therapy.
Authors: Yu-Ce Wei, Qi Fei, Bao-Min Zheng, Yan Xie, Bo Chen, Wei-Xin Liu, Changgong Zhang, Weiping Liu, Hui Fang, Shunan Qi, Di Zhang, Yue Chai, Ye-Xiong Li, Wei-Hu Wang, Yuqin Song, Jun Zhu, Mei Dong
Journal: Journal of Clinical Oncology (2023)

e19523 Background: Advanced-stage ENKTL is characterized by its low prevalence, poor prognosis, and inconclusive optimal therapy. The present study investigated the treatment of newly diagnosed advanced-stage ENKTLs. Methods: Newly diagnosed stage III/IV ENKTL patients from two large-scale Chinese cancer centers in the last 10-15 years were retrospectively collected and analyzed. Results: With a median follow-up of 75.03 (range, 0.33-292.13) months, the median overall survival (mOS) for the 195 newly diagnosed stage III/IV ENKTL patients was 19.43 (range, 0.33-292.13) months, and estimated 1-, 2-, 3-, and 5-year OS were 59.5%, 46.3%, 41.8%, and 35.1%, respectively. First-line multi-modality therapy(n=89) significantly prolonged OS compared to single-modality therapy(n=106)( P&lt;0.001). Chemotherapy(CT)+radiotherapy(RT)(n=47) compared to CT alone(n=93)( P=0.007), and hematopoietic stem cell transplantation(HSCT)(n=20) compared to non-HSCT(n=175)( P&lt;0.001) both significantly improved OS. For patients ≤60 years and ineligible for HSCT, other therapies with complete remission(n=28) led to comparable OS( P=0.160), with no significant difference in baseline characteristics( P&gt;0.05). Four long-term survival patients treated with chidamide maintenance therapy(MT) achieved a median progression-free survival(PFS) of 55.83(range, 53.27-92.33) months and a mOS of 60.65(range, 53.70-95.70) months, preliminarily indicating its positive impact on prognosis. Regarding CT, anthracycline(ANT)-based regimens(n=60), compared to non-ANT-based ones(n=119), led to significantly inferior PFS( P=0.031) and OS( P=0.010); while asparaginase(ASP)-(n=123) compared to non-ASP-(n=56), and gemcitabine(GEM)-(n=56) compared to non-GEM-based(n=123) regimens, both prolonged PFS( P=0.005; P=0.009) and OS( P=0.086; P=0.003). Multivariate analysis further showed that GEM-based regimens improved PFS(HR=0.691, P=0.061) and OS(HR=0.624, P=0.037) compared to non-GEM-based ones. The GEM+ASP(n=42) combinations slightly improved PFS and OS compared to regimens containing either GEM(n=14) or ASP(n=56) alone( P&gt;0.05). The GEM+ASP combinations led to significantly superior PFS( P=0.058[log-rank test], P=0.036[Breslow test]) and OS( P=0.008) compared to the ANT+ASP combinations. First-line “intensive therapy”, including CT(particularly GEM+ASP regimens), RT, HSCT, and chidamide MT, was therefore proposed, and could improve long-term survival for advanced-stage ENKTLs. Conclusions: We propose the first-line “intensive therapy” for newly diagnosed advanced-stage ENKTLs, including CT, RT, HSCT, and chidamide MT. The GEM+ASP combinations appear to yield the optimal efficacy and survival. RT, consolidative HSCT, or chidamide MT are recommended.
Characteristics and outcomes of patients with small cell lung cancer (SCLC) detected with CT screening at a single health system.
Authors: Manasi Manoj Godbole, Pin Li, Kashmira Wani, Matthew Meranda, Michael J. Simoff, Shirish M. Gadgeel
Journal: Journal of Clinical Oncology (2023)

8581 Background: At diagnosis, the majority of SCLC patients have extensive-stage disease, and their median survival is only 13 months, even with the addition of checkpoint inhibitors. Previous CT screening trials did not reveal reduction in mortality for SCLC patients. The aim of our study was to analyze the baseline characteristics and clinical outcomes of SCLC patients diagnosed with low-dose CT scan as a part of lung cancer screening program. Methods: A retrospective chart review-based study of SCLC patients diagnosed clinically or by lung cancer screening between January 2018 and June 2022 at the Henry Ford Health System was conducted. Baseline characteristics, details of SCLC diagnosis and treatment, and outcome were recorded. Statistical analysis was performed using Chi-squared test, T-test and log-rank test. Results: Of the 258 patients who met eligibility criteria, 34 were diagnosed by lung cancer screening. Patients diagnosed with screening tended to be older (mean age- 70.5 years vs. 67.3 years, p=0.010). There were no differences in gender distribution, race and smoking status. Mean smoking history was 43 pack-years in both groups. Among screen-detected patients, 73.5% had limited-stage disease compared to 36.6% among clinically detected patients (p&lt;0.001). No significant difference in the presence of brain metastases at diagnosis was observed. Among screen-detected patients, 97.1% received any therapy compared to 85.3% among the clinically detected patients (p=0.105). Overall survival (OS) was significantly better in screen-detected patients, with a 3-year survival rate of 45.5% vs. 17% (p=0.00027). By multivariable analysis, OS was better in screen-detected patients (HR=0.37, 95% CI 0.20-0.68; p=0.001) (Table). There was no significant difference in progression-free survival between the groups. Conclusions: Our results demonstrate that SCLC patients diagnosed through the lung cancer screening program have better overall survival rates than those diagnosed clinically. These results suggest that developing appropriate screening measures may impact SCLC-related mortality. [Table: see text]
The impact of COVID-19 on a stand-alone cancer support community.
Authors: Carley Mitchell, Jeffrey Zhong, Cheryl Apisdorf, Beth Bennett, Qian Wang, Melinda Laine Hsu
Journal: Journal of Clinical Oncology (2023)

e24203 Background: The COVID-19 pandemic altered cancer care delivery, notably through a rise in telemedicine. Patients of racial minority, low income, or older age are less likely to engage in virtual platforms. Support services are effective ways to combat negative effects of both a cancer diagnosis and a pandemic. However, research is limited regarding the impact of COVID-19 on support-based organizations. We aimed to identify variations in participant demographics and resource utilization at The Gathering Place (TGP), a cancer support community, prior to and during the COVID-19 pandemic, as the platform of program delivery shifted from all in person (IP), to virtual (V), to a hybrid (H) in person/virtual setting. Methods: Deidentified, retrospective data was gathered from three distinct six month time periods: 01/01-06/30/2019 (IP), 01/01-06/30/2021 (V) and 01/01-06/30/2022 (H). Participant data including participant type (diagnosed with cancer or affected by cancer), age, sex, race, residential zip code (translated to projected household income), cancer type and programs utilized were collected and analyzed. Baseline demographics were compared among IP, V and H platforms using the Wilcoxon test (for age) and chi-square tests for other variables. Statistical significance was set at two-sided P values &lt; 0.05. Results: Among participants with cancer, there was a greater percentage of females and racially white vs. black individuals. Sex, race and projected income did not change significantly over time. However, age significantly decreased from IP to V/H settings. The percentage of participants engaging in support, exercise, art and mind/body programs significantly decreased from IP to V/H settings, whereas educational engagement increased. Similar results were recognized among participants affected by cancer. Conclusions: The change in median age at TGP as a result of the COVID-19 pandemic, and subsequent shift in program delivery, mirrors the disparity in telemedicine utilization among the older population. While race and projected median household income did not change over time, the 2019 data suggests that participation is already highly skewed towards white and higher income participants compared to the local demographic distribution. Moving from IP to V/H delivery, program utilization with more interpersonal camaraderie and social bonding decreased, while programs involving less of these qualities remained the same or increased over time. This data highlights important gaps in utilization and underscores the gravity of in person interaction that has been altered by the COVID-19 pandemic. [Table: see text]
How reliable are post-mastectomy breast reconstruction videos on YouTube?
Authors: Nina Morena, Libby Ben-Zvi, Victoria Hayman, Mary Hou, Diana Nguyen, Carrie A. Rentschler, Ari N. Meguerditchian
Journal: Journal of Clinical Oncology (2023)

11021 Background: Social media are a significant source of information for young women with breast cancer (YWBC) undergoing post-mastectomy breast reconstruction (PMBR). The emphasis on visual storytelling and building community in online spaces renders YouTube (YT) to be a common platform for discussions of BR. This study aims to assess the quality of YT videos about PMBR, identify themes related to the PMBR experience, and quantify perceptions of BR as an option PM. Methods: YT was searched incognito with terms “young women breast cancer reconstruction” in 08/2022, in order from most to least viewed. Title, upload date, length, poster identity, number of likes and comments were collected. The Patient Education Materials Assessment Tool for audiovisual materials (PEMAT A/V) evaluated understandability and actionability. DISCERN assessed quality and reliability. Presence of sponsorship, intended audience, patient and healthcare professional narratives, and perceptions of PMBR were collected. Reviewers noted whether PMBR was shown and how. Themes were collected inductively and deductively for thematic analysis. Results: 193 videos were identified. Mean video length was 14.6 minutes (SD 20.0 min). 87.1% included sponsorships. 95.9% of videos were posted by an organization. 60.6% were information-based; 45.6% experience-based. Mean PEMAT scores for understandability and actionability were 71.3% (SD 13.4) and 35.7% (SD 41.8), respectively. Mean DISCERN was 2.6/5 (SD 1.2). Patient narrative was present in 52.6% and healthcare professionals’ in 68.4%. PMBR was visually presented 22.8% of the time. 13.5% of videos explicitly recommended PMBR. 2.6% explicitly discouraged it. Patients (77.7%) represent the majority of the intended audience. Most common deductively identified themes included treatment (87.1%), family relationship (17.1%), motherhood (15.5%), fertility (11.9%). Inductively identified subthemes included differentiating between various options for PMBR surgery, BRCA genetic testing, psychosocial effects of breast cancer and PMBR, and recovery from surgery. Conclusions: YT is a platform wherein various PMBR options are widely discussed and explained. PMBR videos are highly understandable but have moderate levels of actionability, quality, and reliability. Videos are highly sponsored, demonstrating significant institutional bias. Themes are overwhelmingly treatment and surgery-based. Personal themes were present but not dominant. Distribution of PEMAT and DISCERN scores. [Table: see text]